Provider Demographics
NPI:1538113857
Name:WOODS, JAMES RUSSELL (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RUSSELL
Last Name:WOODS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3 EATON AVE
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-3353
Mailing Address - Country:US
Mailing Address - Phone:831-724-4707
Mailing Address - Fax:831-724-4682
Practice Address - Street 1:3 EATON AVE
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-3353
Practice Address - Country:US
Practice Address - Phone:831-724-4707
Practice Address - Fax:831-724-4682
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67005207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0G670050Medicaid
CA0G670050Medicaid